1. PANDAS
(Pediatric Autoimmune Neuropsychiatric Disorders Assosciated with Streptoccocal Infections)
**Similar condition is called PANS, but I will use the term PANDAS throughout
By Michelle Wright

2. What is PANDAS?
A sudden appearance of symptoms that are associated with a Group A streptococcoal infection (often presents as strep throat)
There are 5 main criteria:
OCD and/or dramatic tics that seem to appear overnight
Symptoms that seem to come and go
Young age of onset (usually around ages 6-7)
Neurological abnormalities
Association with streptococcal infection
This is still a relatively new disorder, as it was first identified in 1998
This 6 min video gives you an overview (visual/audio learners!)

3. Other Symptoms Moodiness Irritability Anxiety Separation anxiety
ADHD symptoms
Difficulties sleeping
Bed wetting or frequent urination
Changes in muscle movements (ex. Changes in hardwriting or walking)
Joint pains

4. What Causes PANDAS?
Strep bacteria stays in the human body for long periods of time
It does this by hiding from the immune system as long as possible, by mimicking cells that are found in the child’s heart, brain, skin and joint tissues
Eventually the body recognizes the infection and develops antibodies to fight off the infection
The body attacks the strep molecules, but also attacks molecules that the strep created to mimic the child’s cells
The body then starts to attack the child’s own tissues (the ones that had been mimicked)
If the body attacks brain cells, then PANDAS can develop

5. How common is PANDAS? Only occurs in around 1 in 2000 children
Strep throat is a very common childhood illness, and most children recover normally
The concern about PANDAS occurs when tics and/or OCD like behaviours occur rapidly and intensely after a strep infection

6. How is PANDAS treated?
The first goal is to treat the strep infection with antibiotics
Symptoms often subside or lessen if the infection is no longer present in the body
OCD symptoms can be treated with Behaviour Cognitive Therapy (BCT)
Anxiety and depression can be treated with SSRI medication (Selective Serotonin Reuptake Inhibitors) - commonly referred to as anti- depressants

7. Impact at School
In addition to the symptoms previously mentioned, children with PANDAS may experience these difficulties at school:
Exposure to another strep infection (can worsen symptoms)
Math difficulties
Slow processing
Fatigue
Handwriting difficulties
Absences from school

8. Info for Teachers
The student has an illness, and is not just behaving poorly
The student may require constant supervision
The student may have days when they have trouble functioning in class
Symptoms flare up and worsen at times
During a flare up the student may:
Be violent
Ignore all instructions
Be extremely emotional
Be unable to focus
Have a low tolerance for frustration
Have difficulty problem solving

9. Info for Teachers on Aggression
Some students with PANDAS exhibit aggression (especially during a flare up of symptoms)
They may bite, kick, hit, act aggressively or threaten others
For some students with PANDAS, this is a result of psychotic thinking
Punishment doesn’t work to lessen the aggression
Distracting the student can work in many cases
Minimizing triggers during a flare up (ex. Hunger, sensory overload, change in routine, frustration, pain) can help
First and foremost - keep other students safe

10. How can we help students with PANDAS in the classroom?
Provide a space to rest, with few distractions
Allow student frequent bathrooms breaks
Have a ‘safe person’ that they can go to when feeling anxious (ex. Admin, LST, EA)
Support handwriting difficulties
More space to write, scribing, SEA equipment, speech to text software
Support math difficulties (usually with calculations)
Allow calculator, tape times table sheet to desk
Support processing difficulties
Fewer questions, extra time, oral and written directions

11. It Takes a Village
Many people and resources come together to support a child with PANDAS, including:
Parents
Family Members
Teachers / EAs / School Admin
Family Doctor
Psychologist
Psychiatrist
Occupational Therapist
Specialized Doctors
Parent Support Groups

12. How can teachers ensure that a child with PANDAS reaches their full potential?
Most importantly - recognize that the student has an illness and cannot control their symptoms
There are so many possible symptoms associated with PANDAS, so figure out what the struggles are for your student, and work on supporting each concern (ex. Identify the specific OCD challenges that this student faces. Identify ways to support the child with their handwriting difficulties.)
Communicate frequently with parents!!!
They know their child best! An open line of communication about how things are going at home and school will help both parties effectively support the child.
Provide a safe, supportive environment for the student

13. Discussion Time! If you had a child with PANDAS in your class...
What are the first steps that you would take to support the student?
What accommodations and/or modifications would you put in place?
What questions would you still like answered?

14. References